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Ayurveda And Diabetes During Pregnancy (Gestational Diabetes)

Today is World Diabetes Day

DIABETES : PROTECT OUR FUTURE

Diabetes is the most common medical complication of pregnancy and it has increased about 40% . The increasing prevalence of Type 2 Diabetes in general and younger people in particular has led to an increasing number of pregnancies with this complication .

Women can be separated into :

– those who were known to have Diabetes before pregnancy – Pregestational or Overt

– those diagnosed during pregnancy – Gestational .

There is keen interest in events that precedes Diabetes which includes the mini environment of the uterus , where it is believed that early imprinting can have effects later in life ( Saudek 2002) . For example in utero exposure to maternal hyperglycemia leads to fetal hyperinsulinemia , causing an increase in fetal fat cells, which leads to obesity and insulin resistance in childhood . This in turn leads to impaired glucose tolerance and Diabetes in adulthood . Thus a cycle of fetal exposure to Diabetes leading to childhood obesity and glucose intolerance is set in motion .

GESTATIONAL DIABETES MELLITUS :

Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy . An alternative explanation is that Gestational Diabetes is Type 2 Diabetes unmasked or discovered during pregnancy .

b) Having a previous birth of an overweight baby of 4 kg or more

c) Previous stillbirth

d) Unexplained perinatal loss

f) Persistent glycosuria

g) Age over 30 years

h) Obesity

i) Ethnic groups ( East Asian , Pacific Island)

Screening :

The method employed is by using 50 gm oral glucose challenge test without regard to time of day or last meal , between 24 – 28 weeks of pregnancy . A plasma glucose value of 140 mg percent or that of whole blood of 130 mg percent at 1 hour is considered as cut off point for consideration of a 100 gm ( WHO – 75 gm ) glucose tolerance test .

Complications :

a) Increased perinatal loss is associated with fasting hyperglycemia . Fetal anomalies are not increased due to the absence of metabolic disturbance during organogenesis in early pregnancy.

c) Polyhydramnios

d) Birth trauma

e) Recurrence of GDM in subsequent pregnancies is about 50 %

OVERT DIABETES :

A patient with symptoms of Diabetes Mellitus ( increased urination , increased thirst , weight loss ) and random plasma glucose concentration of 200 mg / dl or more is considered overt diabetic . The condition may be pre existing or detected for the first time during present pregnancy .

According to American Diabetic Association , diagnosis is positive if

a) The fasting plasma glucose exceeds 126 mg / dl

b) The 2 hour post glucose ( 75 gm ) value exceeds 200 mg / dl

Patients with poor glycemic control and vascular disease are at increased risk of complication of IUD , IUGR , Pre eclampsia and Ketoacidosis .

Complications :

MATERNAL :

During Pregnancy :

Abortion

Preterm Labour ( 20% )

Infection – Urinary tract infection and vulvo vaginitis

Increased incidence of Pre eclampsia ( 25 % )

Polyhydramnios ( 25 – 50% )

Maternal distress

Diabetic Retinopathy

Diabetic Nephropathy

Ketoacidosis

During Labour :

Prolongation of labour due to big baby

Perineal injuries

Postpartum haemorrhage

FETAL :

Fetal Macrosomia – With good Diabetic control , incidence of Macrosomia is markedly reduced .

Congenital Malformation – It is related to the severity of Diabetes affecting organogenesis , in the first trimester ( both in Type 1 and Type 2 Diabetes ) .

Birth injuries

Fetal death

NEONATAL :

Hypoglycemia ( < 37mg / dl )

Respiratory distress syndrome

Hyperbilirubinemia

Cardiomyopathy

AYURVEDA :

In Ayurveda Madhumeha disease can be correlated with Diabetes Mellitus . Though there is no direct reference of Gestational Diabetes but GarbhaVriddhi is described as a complication .

Garbha Vriddhi : In Garbha Vriddhi , there is excessive increase in size of abdomen and perspiration . Labour is difficult .

This can be understood as Overweight fetus or Macrosomia .

MANAGEMENT :

Ayurveda helps in limiting the maternal and fetal complications . Herbs are helpful as a supportive treatment along with the modern medicine under supervision .

Generally beneficial , congenial , purifying and suppressive dietetics and mode of life , not causing loss of doshas and dhatus but capable of decreasing the increased doshas and dhatus should be used .

Cereals : Wheat , barley , pearl millet , oats .

Dry Fruits : Almond , apricot , walnut .

Though the most appropriate diet for women with Gestational Diabetes has not been established , it is suggested that obese women with a body mass index greater than 30 kg / m2 may benefit from a 30 – 33 % caloric restriction .

This should be monitored with weekly tests for ketonuria because maternal ketonemia has been linked with impaired psychomotor development in the offspring .